Why you'll get 'bad skin' after going off the contraceptive pill. And what to do about it.

So you decided to go off the contraceptive pill and your skin has lost the plot. Damn.

Give your body a break, they said. Go natural, they said.

But no one mentioned the acne flare ups, bumps along your hairline, extra oily T-zone or general effed up-ness, did they?

Whether you’re looking to change your contraception method or want to start a family, choosing to say ‘cya’ to the pill is a major lifestyle change.

And with change comes consequences.

One of the biggest concerns women have about going off the pill is what will happen to their skin, especially if that was the whole reason you started taking it in the first place. Will all that teenage acne come back as if you’re 16 again?

Turns out the answer to these questions is a lot more complex than removing your makeup at night.

So we asked two dermatologists to explain in detail everything you need to know about why you’ll get ‘bad skin’ after going off the contraceptive pill. And what to do about it.

Why you can get bad skin after coming off the pill

Getting your head around what causes your skin to change (i.e. increased greasiness, more vascular reactivity – blushing, rosacea – acne lesions and flare ups, change in texture, dryness) when you come off the pill is tricky. But it’s important to scrap thinking of withdrawing the pill as the ’cause’ of your bad skin.

“The contraceptive pill, particularly ones containing oestrogen, is a treatment for skin issues. Going off the pill doesn’t cause skin issues, it removes the treatment that’s been controlling the problem for a period of time,”  Central Sydney Dermatology’s Associate Professor Stephen Shumack told Mamamia.

“Like any other form of treatment, when you take it away, you’ll often go back to experiencing the symptoms you would’ve had if you hadn’t been on the pill, but people often take these as new symptoms.”

Assoc. Prof Shumack explained the reason women experience really great skin while they’re taking the pill is thanks to the added oestrogen, which boosts overall skin health and keeps the skin moist and hydrated – “it’s a bit like being pregnant and experiencing the ‘pregnancy glow’,” he said.

“So what happens when you stop the pill, particularly an oestrogen pill, a few months down the track the skin can change because you’re taking away the hormones you were supplementing your skin with. This can result in a bit of acne, skin dryness and some hair loss.”

Along with reducing the amount of oestrogen circulating in your system, coming off the pill is much like taking off a mask and returning to your natural hormonal base line, Dr Adam Sheridan of the Specialist Dermatology Surgery & Laser clinic in Melbourne said.

“Usually a female has started the pill for whatever reason in her late teens or early 20s, and then when they come off the pill because the time’s right to start a family or they’ve been on it for 10 years and want to give their body a break, you reveal the normal hormonal and ageing changes to your skin that have occurred in the years you’ve been on the pill,” he told Mamamia.

“The pill was acting as a treatment for masking acne that would’ve occurred if they weren’t otherwise on the pill.”

At a dermatological level, using the pill to treat acne works in part thanks to a chemical called Cyproterone that dampens or reduces the effect of testosterone on the skin at the skin receptor level, along with the pill’s other actions. In other words, the pill blocks the effect testosterone would normally have on your skin, resulting in clear, hassle-free skin while you’re on the pill.

“Testosterone is an androgen, which has the opposite effect of oestrogen on the skin. It’s ‘pro-acne’ and can cause congestion in the skin,” he said.

“A lot of women will stop the pill and they’ll come in saying their hormones are going crazy and it’s making their skin is bad. If you do a blood test on that patient, often their circulating hormones are completely normal – ruling out Polycystic Ovary Syndrome or any other hormonal conditions – it’s just that their skin receptors for testosterone are hyper sensitive after being blocked by the pill.”

How long does acne last for after coming off the pill?

If your skin has gone haywire after coming off the pill, chances are you’ve heard ‘just stick through it’ before. Yes, the statement can feel patronising, but there is some truth to it.

Assoc. Prof Shumack said in his experience skin symptoms can start three to four months after withdrawing the pill – “it can take three to four cycles for your body to register the changes in hormones” – and can last for up to three to four months after that. The symptoms can hang around for longer depending on what your individual hormonal base line (i.e. your levels of oestrogen and testosterone) is.

Dr Sheridan said there’s quite often two groups when it comes to the way your skin will react to coming off the pill. Which you’ll fall into can be unpredictable.

“One group has this flare while everything sorts itself out – we’d say to this person to give it at least four months or so to see if these issues will continue. Because you’ve changed your hormonal profile, sometimes it can take up to six months to work itself out,” he said.

“The second group may experience symptoms for longer than six months due to hormonal factors or family history, some women have a heightened sensitivity to testosterone at the skin receptor level to your body’s normal hormonal levels.”

A good tip – ask your mum, sister, female cousin or auntie if they experienced acne or skin issues both before going on the pill, or after. This can be an indication of what you might expect, but not always.

How to treat post-pill skin problems

Now you know why your skin has exploded since coming off the pill, which is helpful and all, let’s talk about what to do about it.

While both Assoc. Prof Shumack and Dr Sheridan said preventative planning is your best defence, there’s still some hope if you’re reading this in the thick of post-pill skin hell.

With all treatments, it’s important to keep an open mind, try to be patient and to try different treatments to see what will work for you, Assoc. Prof Shumack advised.

“Everybody is an individual so it’s hard to come down with a blanket statement on what will work. But just because you tried treatments X, Y and Z before [when you were a teenager, for example], doesn’t mean one won’t work now later in life.”

With that in mind, let’s proceed.

We tried the Glam Glow Glitter mask to see if it’s worth the hype. Post continues after video.

Start preparing earlier

Again, condolences to anyone who’s already come off the pill, your bit is coming.

But possibly the best way to avoid or reduce skin symptoms is to start making skincare and lifestyle changes as far in advance as possible. Kind of like prepping for your wedding, Dr Sheriden said thinking about this six months before withdrawing the pill wouldn’t be too much.

“If you know that you’re about to remove the pill and you suspect you might be someone whose skin would flare up – if you had acne earlier in life or your relatives have had similar problems – prep the skin by initiating an acne preventative skin regime,” he said.

“There’s a good chance you’re going to experience changes, so mentally preparing yourself for this is important. Being prepared and having a skincare plan six months out can make you feel in control of a situation that can otherwise feel random.

“Often people don’t appreciate how the stress of having bad skin can contribute to to the problem because your cortisol levels go up and you start picking, and it becomes very stressful. If you can accept these side effects in advance, you can better manage that stress.”

Dr Sheridan also suggested while you’re still taking the pill is a great time to address any skin concerns you have while the pill’s hormones can give you a hand.

“If you’ve had some skin issues while you’re on the pill, you’re only seeing the tip of the iceberg. Rather than discovering the iceberg coming off the pill at a stressful time, [while you’re on the pill] is the time to see your GP or go to a dermatologist to try and address those issues.”

Best products for bad skin after going off the pill

Now to the bit that will make you feel equipped and in control – the products you can buy and try.

Generally speaking, Assoc. Prof Shumack and Dr Sheridan said the following are important to keep in mind and can be implemented before and/or after coming off the pill:

• Keep your skincare regime as simple and neutral as possible. “Avoid dramatic skincare treatments as this can confuse things even more and make it difficult to track and isolate what is affecting your skin,” Dr Sheridan advised.
• Avoid thick moisturising creams, oils and full coverage foundations. Instead go with lightweight lotion or gel formulae. If you can, avoid wearing makeup as often as possible.
• Don’t ditch sun protection. You still need an SPF 50+ sunscreen but choose a lotion or fluid rather than a cream or zinc.
• Choose gentle, pH neutral cleansers. Ingredients like alpha hydroxy acid and glycolic acid can help with acne.

After asking women who’ve been through this horrible coming off the pill business before and scouring the internet for reviews and tips, here are some genuine product recommendations other women say worked for them.

Alpha-H Triple Action Cleanser, $44

Alpha-H Essential Cleansing Balm, $38.25

Gamophen Antibacterial Medicated Soap, $1.50

PHISOHEX Anti-Bacterial Wash, $9.99

Dr. Lewinn's Reversaderm Glycolic Clarifying Cleanser, 2pk x 100mL $26.98

Bioderma Sensibio H2O Micellar Solution, $31.99

The Ordinary Advanced Retinoid 2%, $17.90

Neutrogena Moisturiser Combination Skin Oil Free, $9.69

Cetaphil Moisturising Lotion, $11.29

Neutrogena SPF 50+ Ultra Sheer Fluid, $13.99

Alpha-H Liquid Gold, $60

Dermalogica MediBac Skin Purifying Wipes, $23.32

Mario Badescu Drying Lotion, $24

Whichever products you choose, you will need to be consistent and disciplined with your skincare routine. Oh, and patient. Annoying.

Medical treatments for acne

If you've been experiencing acne flare ups, excessive dryness or any other persistent skin issues for more than six months after coming off the pill, Assoc. Prof Shumack and Dr Sheridan recommended going to speak to your GP or dermatologist about medical treatment options.

These include: a low dose antibiotic for two months, a topical retinoid, systemic vitamin A treatment, or in some cases, going back on the contraceptive pill. This can be a catch 22 if you're trying to conceive.

Diet and lifestyle treatments after going off the pill

From a lifestyle perspective, there are a few things you can adjust to supplement your skincare efforts.

Assoc. Prof Shumack advised quick, cool showers and avoiding all the usual things in excess - maintaining a good diet, not going without sleep for long periods of time and managing stress.

Dr Sheriden also suggested reducing high GI and processed/coloured/refined foods, and avoiding general irritants like alcohol, and any specific to your body (i.e. gluten, lactose). A probiotic to maintain gut health may also help some individuals.

The main message about your skin and coming off the pill is that pimples, redness, bumps and flakes are relatively unavoidable. Accepting and planning for these changes is the best way to get through them.

Even if it doesn't feel like it, you will get through them.

Just not tomorrow.

This article is not to be substituted for personalised medical advice. If you or someone you know is experiencing any of the listed symptoms or is self-conscious about their acne, please seek professional medical advice from a GP, dermatologist or specialist.

How has coming off the pill impacted your skin? What have you found works best for you?